MEDICARE: JOLLYGLO INTERNATIONAL LIMITED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)		IL

General Provider Information

NPI Number	:	1235675372
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOLLYGLO INTERNATIONAL LIMITED

Provider Business Mailing Address
First Line	:	671 MUSKEGON AVE
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-3933
Country	:	US
Telephone Number	:	773-653-6536
Fax Number	:	708-360-5209

Provider Business Practice Location Address
First Line	:	671 MUSKEGON AVE
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-3933
Country	:	US
Telephone Number	:	312-973-6373
Fax Number	:	708-360-5209

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOSEPH O OLUWOLE
Credential	:	M.D
Telephone Number	:	312-973-6373

Provider Enumeration Date	:	01/12/2017
Last Update Date	:	01/12/2017

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Directions to “JOLLYGLO INTERNATIONAL LIMITED ” Practice Location

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